Transmucosal glucose and evidence based medicine

[paramedicmike]

Are there any studies to support the rectal route?

Croaker has an interesting story about this. It's up to him to share it, though.

[Eydawn]

I've given Diastat before in the group home setting for someone who was developmentally delayed and had refractory seizures... mm, suppository! "Hey, man, do you suppose?? Nah...."

Good to know that it doesn't work. I'm printing that study and taking it to the current gig. Got a few diabetics and we have ye old "jelly in the mouth" written as part of our protocol (which I would *never* do, personally as I have no suction available! They're going out on an ambulance if they're that boogered.)

Rectal glucose is taught as part of the WFR course (wilderness first responder) for when you have no IV access, and plenty of time... so is rectal hydration, apparently (eek).

Wendy

CO EMT-B

[croaker260]

OK, here is the short version of the infamous snickers bar story:

Many Many Years ago, in the late 80's, early 90's, a group of paramedics were rafting north of us here is Idaho. A little background is in order to put this in perceptive: Depending on where you were on the river it was HOURS for BLS to get to you on the river, and longer for ALS to get to you via helicopter. If you were lucky.

So...One of these medics is a diabetic, and has a hypoglycemic event due to fun in the sun. These other medics were well educated, and knew the medics history, and could make a reasonable guess to the crisis even without the availability of a glucometer (this was long enough ago there were still using urine strips).

So..no medical gear to speak of, no IV's, no oral glucose, and the fellow medic is unresponsive.

but...they have a snickers bar. Hmmmmmmmm......

Yep, you guessed it. 1 snickers bar, PR!

Apparently it took a bit but it worked quite well.

To this day they have never said who drew the short straw to administer the snickers bar.

Edited April 16, 2012 by croaker260

[DwayneEMTP]

LMFAO...

I just hope to God that a penis never becomes protocol for PR hypoglycemia...

[Just Plain Ruff]

LMFAO...

I just hope to God that a penis never becomes protocol for PR hypoglycemia...

hopefully you aren't the tester for that protocol huh Dwayne????

[ERDoc]

I'll take the hypoglycemic coma, thanks.

[AnthonyM83]

Locally, we can give it by mouth if pt has a gag reflex. Ive been told the intent is that they are likely (not certainly) to also have a swallow reflex...so we're really giving in PO, not SL/transmembrane..... I dont know if their logic is correct, but it's one step more conservative than giving it all unresponsive suspected hypoglycemic patients ....

[Just Plain Ruff]

If you can't get a vein, you cant give it rectally and you can't give it orally, then do any of you have the ability to drop a NG tube, and give it diluted slightly and down an NG tube?

[Chief1C]

As a person that is not exactly compliant with meds, and diabetic... If it were to come to either choking to death on thick gooey cherry gel.. or having the same squeeze up my back side.

PLEASE, LET ME DIE! Clearly, it was meant to be.

Protocol states not to put anything into the mouth of someone unconscious. I tend to side with that, instructors always said go ahead, what can it hurt?

Well, we made a hell of a mess one evening, to prove a point to the instructor. The punishment? I bet it was a bitch to get that stuff out of Resusci-Anne's mouth. Glucose that is, sick bastards. I squeezed that thick ass cherry Instaglucose gel in, and squeezed another tube onto a paper plate. I said, there is "THAT" much in there, the patient is choking, suck it out. The suction unit kept getting clogged, or it just wouldn't siphon the glucose globs.

Point was given, point was shoved down her throat, and point was well received.

I prefer Glutose 15, in the grape flavor; or Dex4 GlucoShots (lemon/lime liquid) for myself. And I eat the tablets like candy.

[Just Plain Ruff]

You know I'm a diabetic, I've not hit the hypoglycemic stage yet and I hope to never get there. My sugars have usually run around 140 - 180 fasting. I know that doesn't seem particularly high but when you run them continuously for months and then every once in a while you hit a number of let's say 80 or 90 you get a little flubbered.

The key to my diagnosis was stepping on a lego and cutting my foot and it didn't heal for 5 months. My wife after 3 months said "dumb ass we're going to the doctor and getting an A1C done" and guess what. It was 9.5 Now I'm diabetic. My numbers are now 7.4 or lower a bit. Depends on how compliant I'm with my meds and sodas and food the month before.

So when I run 140 - 160 for the week and hit a number of 80 or 90 I get head aches like today and my sugar is 95 so I go grab a soda. I only know that it's a matter of time before I wake up somewhere and see a paramedic surrounded by a bunch of firemen who remind me of a bunch of guys who frequent the city here all wanting to stuff things down all the orifices they can find but all the while pushing an amp of D50, I'm going to wish I had excercised a bit more.

But to get bck to topic, please don't put anything in my mouth if I'm unresponsive, I'd rather have a IO needle in my tibia than a aspiration pneumonia that puts me in the hospital for a month rendering me unable to work. If the EMS books say nothing by mouth to a person without a GAG reflex, then please do what they say, don't put something in there and disregard the books, there's a reason for them saying that. Evidence or not.

Now, YOu should not have any problems getting an IV On me, I have pretty damn fine veins, my heroin dealer told me so,er I mean the anethesiologist at my PPUV surgery (find that on the internet) told me that my veins were garden hose variety.